Some preliminary studies have already suggested that imbalances in the microbiome of long Covid patients could be contributing towards their persistent inflammatory symptoms. But while more research is likely to be needed before medications like prebiotics or anti-inflammatories are recommended for long Covid patients as part of general clinical practice, some individual symptoms are already proving more treatable than others.
Heightman says that long Covid patients displaying allergic-type reactions tend to respond well to anti-histamines, while Amy Kontorovich, a cardiologist at Mount Sinai who specialises in treating dysautonomia, has developed a novel physical therapy programme known as Autonomic Conditioning Therapy (ACT) which has shown the ability to reduce fatigue symptoms in some long Covid patients, and has since been adopted by 53 physical therapy centres across the New York area. Kontorovich explains that ACT begins with range of motion exercises, before progressing to different aerobic exercises which slowly increase in intensity, but never allow the patient to exceed 85% of their maximum heart rate. This is inspired by a similar reconditioning programme, which has been shown to be effective in treating a form of dysautonomia, known as POTS.
“It seems to program the autonomic nervous system to kind of rewire things,” she says. “One of the interesting trends I’ve seen in many of the long Covid patients I’ve treated, is that they were previously very active, and during the time of their acute illness, they were either laid up in bed or mainly sedentary. That period of inactivity may be a contributing factor for the post Covid dysautonomia pattern, because we know that that can happen with deconditioning.”
ACT is not a complete panacea – Kontorovich points out that some patients with particularly severe dysautonomia are often unable to complete the programme, because they feel too unwell – but her early results show that it can benefit patients who are able to finish it.
Heightman adds many long Covid patients also simply get better over the course of time, as their body recovers and heals. As SARS-CoV-2 has still only been around for a little over a year and a half, it remains too early to say how long chronic symptoms may last. “I don’t want anyone who’s got long Covid symptoms to feel really frightened that this is never going away, because a very significant proportion of people do get better within the first year,” she says.
For those who continue to struggle, however, the hope is that the millions of dollars of research grants being handed out will yield some viable treatment possibilities, otherwise long Covid may leave indelible social and economic consequences on society. “If we don’t find answers, you could be talking millions of people who are not going to be able to work the same way,” says Kaufman. “A very significant proportion of long Covid patients are healthcare workers. These are educated, active, highly productive people who now can’t function. The impact of that is going to be huge.”
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